| Revive Psychological Services P.c. | |
|
1420 Tower Hill Dr Woodridge IL 60517-7674 | |
| (312) 961-1557 | |
| Not Available |
| Full Name | Revive Psychological Services P.c. |
|---|---|
| Speciality | Psychologist |
| Location | 1420 Tower Hill Dr, Woodridge, Illinois |
| Authorized Official Name and Position | Geetha Munisamy (DIRECTOR) |
| Authorized Official Contact | 3129611557 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Revive Psychological Services P.c. 1420 Tower Hill Drive Woodridge IL 60517-7674 Ph: (312) 961-1557 | Revive Psychological Services P.c. 1420 Tower Hill Dr Woodridge IL 60517-7674 Ph: (312) 961-1557 |
| NPI Number | 1407146376 |
|---|---|
| Provider Enumeration Date | 04/13/2011 |
| Last Update Date | 04/13/2011 |
| Medicare PECOS PAC ID | 8820426554 |
|---|---|
| Medicare Enrollment ID | O20200312000074 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1407146376 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 103TC0700X | Psychologist - Clinical | 071008111 (Illinois) | Primary |
| Provider Name | Geetha Munisamy |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1700175833 PECOS PAC ID: 6608180617 Enrollment ID: I20200312000197 |
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